体外受精-胚胎移植中卵巢低反应的治疗进展

Therapy for the Poor Ovarian Responses in IVF-ET

卵巢低反应是体外受精-胚胎移植(IVF-ET)过程中超促排卵的难题,表现为卵巢在超促排卵中效果不理想,以超促排卵后获卵子数目少和血雌二醇(E2)水平低为特征,常导致患者取消治疗周期,其发生率约占接受IVF治疗妇女的9%～24%。卵巢低反应的机制尚不明确,目前诊断标准不统一。卵巢低反应的原因多种多样,研究人员一直在考虑使用不同的药物和方案改善这部分患者的治疗结局:①增加促性腺激素的用量。②垂体降调节方式。③添加雄激素。④添加生长激素。⑤采用自然周期或微刺激方案。⑥使用口服避孕药、雌激素。尽管处理不良反应的方法很多,但目前仍缺乏能有效逆转卵巢对超促排卵反应不良的方法,采用一种适合的个体化方案可能是在这种困境当中的唯一选择。

The poor ovarian response,a problem of controlled ovarian hyperstimulation in IVF-ET,is characteristic of the poor outcome of ovarian hyperstimulation failure,the limited number of recruit follicles,and lower E2 level,which often leads to the cycle cancel of IVF-ET.The incidence of poor response in IVF-ET is 9% to 24%.The mechanism of poor ovarian response is not well clarified;even the diagnosis standard is skimble-scamble.Various treatment protocols were proposed to improve the ovarian reactivity of patients with the poor ovarian response.These protocols were listed as follows：① Increasing the stimulation dose of rFSH.② Pituitary down regulation.③ The use of androgens or androgen-modulating agents.④ Administration of growth hormone.⑤ Modified natural cycle IVF.⑥ Adjuvant therapy such as the use of oral contraceptive pill（COCP）,E2.There is little understanding which one is the best protocol to treat effectively the poor ovarian response.It could be a feasible choice for different individual to have a suitable and personalized protocol.